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The following is a summary of “LC-OCT for early diagnosis and characterization of dermatologic adverse events to oncologic drugs and correlation to histopathology,” published in the November 2024 issue of Dermatology by Sollena et al.
Targeted and immune therapies associated with multiple cutaneous toxicities are often challenging to differentiate clinically without histology. Line-field confocal optical coherence tomography (LC-OCT), a non-invasive imaging technique, showed promise in diagnosing various skin conditions.
Researchers conducted a retrospective study to evaluate the effectiveness of LC-OCT in predicting the clinical evolution of early maculopapular eruptions induced by antineoplastic targeted therapy and immunotherapy.
They enrolled patients with clinical cutaneous maculopapular reactions from oncologic targeted therapy or immunotherapy at the dermatologic outpatient clinic of the Fondazione Policlinico A. Gemelli IRCCS, Rome, between May 2023 and December 2023. Each patient underwent a clinical dermatological examination, video-dermoscopy, line-field confocal optical coherence tomography (LC-OCT), and incisional skin biopsy of a target lesion and assessed the evolutionary patterns of maculopapular lesions (psoriasic eruption, lichenoid eruption, eczematous eruption, bullous eruption), LC-OCT and histopathological images, and were compared based on characteristics such as hyperkeratosis, acanthosis, spongiosis, papillomatosis, lichenoid inflammatory infiltrate, and the presence of an intraepidermal/subepidermal cleavage plane causing bulla formation.
The results showed that 18 patients (11 males, 7 females, median age 64.5) were included, LC-OCT had an overall concordance of 77.8% with histology (Cohen’s Kappa 0.69, P<0.0001). Sensitivity exceeded 70%, specificity was ≥88.2%, and AUC ranged from 0.9-1 for psoriasis and lichenoid eruptions and 0.7-0.9 for eczematous and bullous eruptions.
They concluded LC-OCT as a primary tool for early differential diagnosis of adverse skin reactions to targeted therapy and immunotherapy, potentially reducing the need for skin biopsies in patients with cancer.
Source: onlinelibrary.wiley.com/doi/full/10.1111/ijd.17520
